Evaluation of Serum C24 Ceramide as a Predictor of Hepatic Decompensation in Patients with Liver Cirrhosis

Abstract

Background: It was found that there is a significant progressive decrease in the serum level of C24 ceramide with increasing severity of cirrhosis. Our aim was to evaluate the efficacy of C24 Ceramide (C24Cer) as a predictor of decompensation in cirrhotic patients at Suez Canal University hospital, Ismailia, Egypt. Subjects and Methods: Patients with viral related liver cirrhosis were consecutively confronted in the outpatient and inpatient sections. They were classified according to Child-Pugh into A, B, C groups. A control group (13 individuals) was compared with each group. Clinical assessment and Liver profile were performed. The serum level of C24Cer was measured using 20μL extracted serum with methanol: chloroform: HCl (15:83:2), using liquid chromatography coupled to tandem mass spectrometry. Results: Patients with Child-A cirrhosis showed a significantly higher mean C24Cer level compared to Child-C patients (p <0.001). Pairwise comparisons showed a statistically significant stepwise decrease in the mean C24Cer level from control group to Child-A, B then C cirrhotic patients respectively (p-value: 0.029, <0.001, and <0.001). There was a highly significant negative correlation between C24Cer and each of total bilirubin, PT, ascites grade, hepatic encephalopathy grade, and Child score (p < 0.001 for each) as well as a highly significant positive correlation with albumin level (p < 0.001). Conclusion: a low serum C24Cer is associated with hepatic decompensation and is good with a sensitivity of 100% and a specificity of 73%. Further studies are needed to elucidate the real-life significance of C24Cer as a non-invasive mortality predictor in cirrhosis.